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The pandemic led to an increase in remote monitoring of patients

Devices that remotely transmit people’s weight, blood pressure and glucose levels to doctors became very popular during the COVID-19 pandemic as people became socially isolated, according to a to study published on September 6 in Health Matters. However, this increase was not evenly distributed, as a small number of primary care physicians generated the most billing claims.

The idea is for doctors to adjust patient care plans in response to these data sources from remote patient monitoring (RPM) devices, the researchers said, adding that people with multiple chronic conditions, such as hypertension or uncontrolled type 2 diabetes, could benefit more. But the researchers did not find precise targeting of RPM services to people most at risk.

At least one observer noted that the distribution of billing was so uneven (0.1% of providers in this sample filed 69% of claims) that it could indicate fraud.

“People were probably billing these codes without actually doing remote monitoring of patients,” said Joseph Ross, MD, MHS, a professor of medicine and public health at Yale University, New Haven, Connecticut, who was not involved in the study. analysis but studies trends in the clinical adoption of tools such as RPM devices.

But the authors of the new study said misbehavior was unlikely and pointed to other explanations for the findings.

mitchell tan

“I wouldn’t jump to the conclusion that RPM’s high concentration of billing suggests fraud,” said Mitchell Tang, a doctoral student at Harvard Business School, Boston. Tang noted that while the upfront costs of offering RPM services, such as purchasing the devices and incorporating them into care workflows, are substantial, the systems are easy to scale. It could be that a small number of vendors have taken these steps while the majority have not, Tang said.

“We have no reason to suspect fraud here,” added Ariel D. Stern, PhD, an associate professor at Harvard Business School and the paper’s lead author.

Claims Analysis

Early in the COVID-19 pandemic, Medicare regulators and commercial insurance companies eased billing for RPM services to promote telehealth care in the absence of in-person visits, which had effectively ceased.

The researchers analyzed the claims of the OptumLabs Data Warehouse, which includes medical billing records for approximately 20 million people in the United States. They examined claims from January 2019 through March 2021, allowing comparison of billing trends before and during the early part of the pandemic, which became a public health emergency in March 2020.

Primary care provider billing claims for RPM increased more than 400% between March 2020 and March 2021, Harvard researchers found, rising from 4,355 claims in February 2020 to 19,762 claims in March 2021. In 2020 , 342 “high-volume” providers: 0.1% of sampled physicians were responsible for 69% (n = 34,406) of all RPM claims.

Based on Medicare reimbursement rates, the researchers estimate that each RPM patient generated an average of $706 in billing charges during their first year of using RPM services. If each of the 342 high-volume providers billed RPM’s services equally, they would have earned approximately $71,000 on those claims.

Tang and colleagues stratified patients seen by high-volume providers by disease severity, as measured by complicated hypertension or poorly controlled diabetes (A1c ≥ 7%), or the presence of many other chronic conditions, such as sleep disturbances or high cholesterol. Patients with more severe disease were not more likely to receive RPM services. For example, 22.1% of patients with well-controlled diabetes and 21.9% of those with control received RPM services in 2020.

“One would expect something that can be quite expensive to be disproportionately targeted at those who could benefit most,” Tang said.

The underlying rationale for RPM is that continuous monitoring improves patient outcomes, but Ross says that remains to be seen.

“The most common RPM systems are in heart failureand have been consistently shown to be of no benefit in randomized trialsRoss said.

Tang said that in future work, he plans to explore whether increased use of RPM is related to better medication adherence and a decrease in acute care visits. Stern added that the investigation is aimed at ensuring that any changes to reimbursement policies for RPM services are based on data.

Tang reports on funding from the Commonwealth Fund. Stern is a visiting scholar at the Hasso Plattner Institute Digital Health Center in Potsdam, Germany, and reports other income from the Health Innovation Hub, an independent think tank associated with the German Federal Ministry of Health. Ross reports that he has no relevant financial conflicts of interest.

health matters. Published online on September 6, 2022. summaries

Marcus A. Banks, MA, is a New York City-based journalist who covers health news with a focus on new cancer research. His work appears in Medscape, Cancer Today, The Scientist, Gastroenterology & Endoscopy News, Slate, TCTMD, and Spectrum.

For more news, follow Medscape on Facebook, Twitter, InstagramY Youtube


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